UNIVERSITY OF CALGARY



Running Head: Stacked Deck

Stacked Deck: An Effective, School-Based Program for the Prevention of Problem Gambling

Robert J. Williams, PhD

University of Lethbridge

Robert T. Wood, PhD

University of Lethbridge

Shawn R. Currie, PhD

University of Calgary

January 25, 2008

Submitted to the Journal of Primary Prevention

Abstract

School-based prevention programs are an essential component of problem gambling prevention, but empirically effective programs are lacking. “Stacked Deck” is a set of 5-6 interactive lessons that teach about the nature of gambling; the true odds and ‘house edge’; signs, risk factors, and causes of problem gambling; and skills for good decision-making and problem-solving. An overriding theme of the program is to approach life as a ‘smart gambler’ by determining the odds and weighing the pros versus cons of your actions. The program was administered to 1,253 grade 9 – 12 students in 10 schools throughout southern Alberta, with results compared to 433 students in 4 Control schools. Three to seven months after receiving the program, students had significantly more negative attitudes toward gambling, improved knowledge about gambling and problem gambling, improved resistance to gambling fallacies, improved decision making and problem solving, decreased gambling frequency, and decreased rates of problem gambling. There was no change in involvement in high risk activities or money lost gambling. These results indicate that the “Stacked Deck” curriculum has promise as a primary prevention initiative.

Key words: gambling, prevention, problem, youth, adolescent, school

Introduction

The past 30 years has seen a dramatic increase in the worldwide availability of legalized gambling opportunities. With increased availability has come increased participation and increased rates of problem gambling. Problem gambling is defined as gambling that has resulted in significant negative consequences for the individual or people in that person’s immediate social network. It includes ‘pathological gambling’, or ‘compulsive gambling’ in which afflicted individuals also show evidence of loss of control and withdrawal symptoms such as craving. Among adults, the prevalence of problem gambling in North America increased significantly from 1977 to 1993 (Shaffer, Hall, & VanderBilt, 1997). In 2001, it was estimated that 4.0% of North American adults met criteria for either problem or pathological gambling in the past year (Shaffer & Hall, 2001). Worldwide prevalence studies since 2005 have found past year adult rates of 0.6% to 5.4%, depending on the country (AGRI, 2008).

Rates among youth are even higher. National prevalence studies in the United States, Canada, Australia and Sweden have found problem gambling to peak in the age group 18 to 24 (Gerstein et al., 1999; Productivity Commission, 1999; Statistics Canada, 2003; Rönnberg et al., 1999). Similarly, a meta-analysis of North American prevalence studies found that lifetime rates of problem gambling were highest in college and university students (16.4%), followed by adolescents (11.8%) (Shaffer & Hall, 2001). The elevated rates among youth are likely due to the fact that young adults typically have the highest rates of involvement in most risky behaviours (substance use, reckless driving, unsafe sex, etc.) (e.g., Eaton et al., 2006), as well as the fact that this is the first generation to have been raised in an environment of extensive legalized and government-sanctioned gambling.

The biopsychosocial model posits that problem gambling develops through a complex interaction between many different endogenous attributes of the individual and exogenous stimuli in the environment (National Research Council, 1999; Petry, 2005; Williams, West & Simpson, 2007a; 2007b). The relative influence of different risk factors in contributing to the development of problem gambling varies from person to person, as does the age of onset. Since a multitude of internal and external factors contribute to problem gambling, prevention requires coordinated, extensive and enduring efforts between effective policy initiatives constraining the availability and provision of gambling, and effective educational initiatives intended to change internal knowledge, attitudes, beliefs, and skills so as to deter an individual from risky gambling behaviour (Nation et al., 1993; Stockwell, Gruenewald, Toumbourou, & Loxley, 2005; Williams, West, & Simpson, 2007a; 2007b).

A wide array of educational and policy initiatives to prevent problem gambling are currently being developed, tested, and used (Williams et al., 2007b). School-based programs are particularly important part of an overall prevention strategy because they provide an intervention to individuals who may not yet have engaged in the behaviour, as well as an age group that is at particular risk for subsequent problem gambling. Furthermore, if successful, educational interventions have the potential to provide long-term deterrence to risky gambling behaviour in a wide array of environments/contexts.

Current school-based problem gambling prevention programs exist on a continuum. At one end are the many videos, plays, interactive CDs, websites, resource manuals, and one-session presentations developed and often delivered by governmental health, social service, education, and/or addiction agencies (see Ferentzy, Turner, & Skinner, 2006 & Williams et al., 2007b for listing of some of these). At the other end are much more substantive multi-session programs delivered over a longer time frame. Examples of this latter type include: “Don’t Bet On It” in South Australia for ages 6 to 9; “Gambling: Minimising Health Risks” in Queensland for grade 5; “Facing the Odds” in Louisiana for grades 5 to 8; “All Bets are Off” in Michigan for grades 7 and 8; “Kids Don’t Gamble…Wanna Bet” in Minnesota and Illinois for grades 3 to 8; “Youth Making Choices” for high school students in Ontario; “Count me Out” in Quebec for ages 8-17; and the “Problem Gambling Prevention Program” in Florida for middle and high school students. The content of school-based programs is diverse, but they usually contain one or more of the following elements: information about the addictive nature of gambling, signs of problem gambling, available treatment resources, guidelines or suggestions for problem-free gambling, true gambling odds, gambling fallacies, exercises to build self-esteem, and peer resistance training.

To date, only a few of these programs have been formally evaluated. The Addiction Foundation of Manitoba evaluated their 45 – 60 minute gambling education and awareness presentation (“It’s Your Lucky Day”) among 894 grade 7 and 8 students in Manitoba (Lemaire, de Lima, & Patton, 2004). One month after receiving the presentation, students in the Intervention group showed improved knowledge of gambling and problem gambling as well as decreased gambling fallacies relative to students in the Control group. The International Centre for Youth Gambling Problems and High-Risk Behaviours (IGYGPHRB) in Montreal, Quebec undertook an evaluation of their interactive CDs for the prevention of problem gambling (“Hooked City” for grade 7 – 12 students and “The Amazing Chateau” for grades 4 – 6). Several months after being exposed to these interactive CDs, students had significantly improved knowledge about gambling, more awareness of the signs of problem gambling, and fewer gambling fallacies. However, there was no significant change in gambling behaviour, although there was a trend in this direction (IGYGPHRB, 2004).

Robert Ladouceur and his colleagues at Laval University in Quebec have conducted several evaluations. Gaboury and Ladouceur (1993) evaluated a 3-session program (75 minutes per session) among 289 juniors and seniors from 5 Quebec high schools. The program included an overview of gambling, discussion of legal issues, how the gambling industry manipulates the chances of winning, gambling fallacies, development of problem gambling, and coping skills. Six months later, students in the Intervention group had improved knowledge about gambling relative to the Control group. However, the improvement in coping skills seen after training was not maintained at 6 month follow-up, nor was there any significant change in students’ actual gambling behaviour or attitudes toward gambling at either post-test or follow-up. Ferland, Ladouceur and Vitaro (2005) evaluated a somewhat different 3-session program (60 minutes per session) with 1193 Quebec students in grades 8, 9 and 10. The program focused on the nature of gambling, gambling fallacies, social problem solving to resist peer pressure, and excessive gambling. Three months later, students in the Intervention group demonstrated a significant improvement in knowledge about gambling, and a decrease in gambling misconceptions relative to the Control group. However, there was no improvement in their social problem solving ability or change in their level of gambling participation.

The Laval University group has also conducted several evaluations of shorter interventions. These involve a 20 minute video (Ladouceur, Ferland, & Vitaro, 2004; Lavoie & Ladouceur, 2004; Ladouceur, Ferland, Vitaro, & Pelletier, 2005); a 40-60 minute interactive presentation (Ladouceur, Ferland, & Fournier, 2003; Ladouceur, Ferland, Roy, et al., 2004); and a combination of video and presentation (Ferland, Ladouceur, & Vitaro, 2002). Follow-up evaluations were usually conducted immediately after the intervention or one week later and with results compared against a control group of students that did not receive the intervention. In all cases, significant improvements in general knowledge about gambling, knowledge about problem gambling, and/or decreases in gambling fallacies were obtained, with the results being dependent on the specific focus of the intervention.

Summary and Research Goal

To summarize, school-based programs are an essential part of an overall problem gambling prevention strategy. Several programs exist; however, very few of these have been evaluated. The ones that have been evaluated have reliably obtained improvements in knowledge about gambling and problem gambling as well as a decrease in gambling fallacies. Most of these programs have not evaluated actual behavioural change. The few that have, however, have not found evidence of skill development or a significant change in gambling behaviour. (Note: This review has not included the handful of university and college based programs that have also been evaluated. See Williams et al. (2007b) for details of these programs and their effectiveness.)

In many ways, these results mirror results found in other areas of prevention. In general, educational efforts to improve peoples’ awareness or knowledge of risky health practices is often successful (Centre for Addiction and Mental Health [CAMH], 1999; Duperrex, Roberts, & Bunn, 2002; Grilli, Ramsay, & Minozzi, 2004; Sowden & Arblaster, 2005). However, while knowledge and attitudinal changes have been fairly reliably obtained, the ability of educational initiatives to produce actual changes in behaviour is much less common (CAMH, 1999; Duperrex et al., 2002; Faggiano et al., 2005; Franklin, Grant, Corcoran, Miller, Bultman, 1997; Grilli et al., 2004; Slater et al., 2005; Sowden & Arblaster, 2005; Stacy, Bentler, & Flay, 1994; cf. Mytton, DiGuiseppi, Gough, Taylor, Logan, 2006). Even with more substantive interventions, effects on the desired behaviour have often been small (Etter & Bouvier, 2006; Foxcroft, Lister-Sharp, & Lowe, 1997; Merzel & D’Afflitti, 2003; Sowden & Stead, 2000; Thomas & Perera, 2006; Wandersman & Florin, 2003), nonexistent (Gates, McCambridge, Smith, & Foxcroft, 2006; Secker-Walker, Gnich, Platt, & Lancaster, 2002), and occasionally in the opposite direction (Roberts et al., 2001).

Needless to say, it is essential that effective school-based programs for the prevention of problem gambling be identified and put in place. Furthermore, in identifying effective programs it is important to focus on meaningful behavioural change as the primary measure of effectiveness. Improvements in awareness, knowledge or attitudes are of value as intermediate steps in the right direction, but of very limited importance if not accompanied by behavioural change. Furthermore, developing these initiatives in the context of a theoretical model of behavioural change (e.g., Health Beliefs Model; Janz et al., 2002) will help improve the likelihood of a successful outcome. The purpose of the present study is to address this need for a behaviourally effective school-based problem gambling prevention program.

Methodology

Program Development

The nature and content of the “Stacked Deck” program was derived from existing programs, what is known about the causes of problem gambling, and a careful study of effective strategies for behaviour change from primary prevention programs in other areas (Capuzzi & Gross, 2000; Durlak, 1997; Durlak & Wells, 1997; Lipsey & Wilson, 1993; Mullen, Simons-Morton, & Ramirez, 1997; Weissberg & Gullotta, 1997). As much as possible, there was also incorporation of what was known about effective educational strategies in schools (e.g., Borich, 2006; Elliot, Kratochwill, & Cook, 1999; Hunt, Touzel, & Wiseman,1999).

The program consisted of five basic lessons (Standard Program) with an optional sixth lesson (Booster Program):

Lesson 1: Nature of Gambling. This focused on the definition, history and types of gambling; legal ages for gambling; the odds of traditional gambling games; and the insurmountable long-term advantage of the ‘house edge’.

Lesson 2: Problem Gambling. Lesson 2 discussed the addictive potential of gambling; the signs and symptoms of problem gambling; causes and risk factors for problem gambling; and where to get help for gambling problems.

Lesson 3: Gambling Fallacies. This lesson consisted of exercises to make students less susceptible to errors in thinking that contribute to gambling such as a selective memory for wins, superstitious beliefs/conditioning, illusory belief of control, the influence of early big wins, misunderstandings of randomness, ignoring the law of averages, and the belief that money can solve all problems (Joukhador, Maccallum, & Blaszczynski, 2003; Toneatto, Blitz-Miller, Calderwood, Dragonetti, & Tsanos, 1997).

Lesson 4: Decision Making and Problem Solving. There is good evidence that problem gambling is typically part of a broader pattern of high-risk behaviours, characterized by core deficits in decision-making, judgement, and problem solving skills (Dickson, Derevensky, & Gupta, 2002). Hence, the message of this lesson is that everything you do is a gamble, and the important thing is to approach life as a ‘smart gambler’. This is done by being a ‘problem solver’ and routinely assessing whether: a) the odds are in your favour, b) what you could win is of significant value, and c) what you could lose is something you can afford to lose.

Lesson 5: Barriers to Good Decision Making and Problem Solving. This focused on examining the reasons why we sometimes take ‘bad gambles’ or make bad decisions (i.e., peer pressure, not having all the information, not being objective, not taking time to weigh the pros versus cons). The second part of this lesson addressed ways to overcome these barriers, particularly peer pressure. For adolescents, gambling activities are typically social in nature, such as playing cards for money, or betting against friends on a sporting event (Gupta & Derevensky, 1998; Hardoon & Derevensky, 2001). Successful treatment of adolescent substance abuse usually requires addressing issues of peer pressure and peer group activities (Williams & Chang, 2000). It is almost certain that the same issues are relevant for the prevention of problem gambling.

Lesson 6: Quiz Game. In some schools students were exposed to a sixth “Booster” session given at least one month after receiving Lesson 5. In this lesson, the class is divided into two groups who compete for the high score on the basis of their answers to 20 questions derived from Lessons 1 to 5. The correct answers are discussed in detail. The primary purpose of this Lesson 6 is to consolidate the knowledge and skills learned in Lessons 1 to 5.

While the educational content of any primary prevention program is crucial to its success, it is equally important to structure the program in such a way that students can easily engage, absorb, and retain the content. Thus, a substantial amount of attention was devoted to the format of the program, such that it incorporated the following important features:

1. An entertaining and engaging delivery. The program relied strongly on visual elements, which are typically engaging for contemporary youth. To that end, the program incorporated videos about problem gambling, and all lessons were presented via PowerPoint® slides. All lessons were highly interactive, requiring the active participation of all students in group discussions, games, and small group exercises. Additionally, the researchers endeavoured to select Research Assistants with dynamic and personable teaching styles to deliver the program.

2. A strong emphasis on skill learning and application of knowledge. Most problem gambling prevention programs have only been one session long, which may help explain the lack of behavioural changes. It is well established that prevention programs that emphasize skill development and corrective feedback over a longer period of time achieve better outcomes (e.g., Driskell, Willis, Copper, 1992; Tobler et al., 2000; Wilson, Gottfredson, Najaka, 2001). Hence, the “Stacked Deck” program is presented over five sessions with each session lasting up to 100 minutes. The program was also often distributed over a two week period and therefore took advantage of the superior skill retention that reliably occurs with spaced practice over massed practice (Dempster, 1989; Donovan & Radosevich, 1999). Further to this end, the sixth ‘Booster’ session was always scheduled one month after Lesson 5.

3. Targeting the social environment (i.e. peers) of the people receiving the intervention. The impact of individual skill development is limited unless there are also environmental changes that decrease the opportunities, acceptability, and pressure to participate in gambling activities. This is especially true of the more socially oriented types of gambling engaged in by adolescents. Environmental changes were accomplished by targeting entire cohorts of students in many of the Intervention schools. In other words, ensuring that all students in that particular grade or course were exposed to the “Stacked Deck” curriculum, as they are the main peers of other students in that grade/course. In addition, as part of the program, several schools ran poster contests where students created problem gambling awareness posters and competed for a prize for the best poster. Many of these posters were placed at strategic locations in the various schools to further raise awareness of problem gambling. The greater effectiveness of these more pervasive approaches has been demonstrated both in primary prevention (Durlak & Wells, 1997; Sowden & Arblaster, 2002; Spinks, Turner, Nixon & McClure, 2005) and in the treatment of addictive behaviours (Miller, Wilbourne, & Hettema, 2003; cf. Secker-Walker, Gnich, Platt & Lancaster, 2002).

A pilot program consisting of these above elements was tested in 2001/2002 in two Calgary, Alberta high schools (Davis, 2003; Williams, 2002). In 2003 the program was revised based on these results as well as feedback from teachers and students.

Study Design

The revised Stacked Deck program was implemented between January 2003 and June 2005 by five trained Research Assistants. A total of 1,253 grade 9 – 12 students in 10 schools in southern Alberta received the program (in the three urban centres of Calgary, Lethbridge, and Medicine Hat and the four rural communities of Coaldale, Vauxhall, Taber, and Cardston). In addition, 433 students in 4 different schools (in Calgary, Lethbridge, Coaldale, and Cardston) were in a Control Group that completed the Baseline and Follow-Up questionnaires, but did not receive the program. Control schools were chosen to provide comparability to the Intervention schools in terms of urban/rural split, school enrolment numbers, and student demographics. All Control schools subsequently received the program and became Intervention schools. In most schools, the lessons were administered in the “Well Being” unit of the ‘Career and Life Management’ course that all Alberta high school students are required to take. However, in some schools it was administered in the Health class.

One to two weeks prior to implementation, students were notified they would be participating in a problem gambling prevention program and were provided with parental consent forms. These forms described the lessons and asked parents to sign and return the form if they did not wish their son/daughter to participate in its evaluation (i.e., filling out the Baseline and Follow-Up Questionnaires). No permission was sought for participating in the program, as its content was consistent with the goals of the Career and Life Management or Health class in which it was taught. (The above protocol was approved by the University Ethics Committee). Almost no parental forms were returned, resulting in a very high rate of eligible participation.

Assessment

At the beginning of the first lesson students were administered a Baseline Questionnaire (Appendix A) to assess their “general gambling knowledge, attitudes and behavior”. They were told that completion of the Questionnaire was optional, but if they completed both the Baseline and Follow-Up Questionnaires, they would receive $10 (cash in some schools, gift certificates at other schools). It was further explained that their responses would be anonymous. We did not need their name, only their birth date, mother’s first name, and last 2 digits of their telephone number to match the Baseline Questionnaire with the Follow-Up Questionnaire. Furthermore, students were assured that all information collected would be strictly confidential with no one outside the research team having access to the data.

The Baseline Questionnaire collected demographic information and assessed the following areas (the lack of established scales in several of these areas required the development of several new scales which were field tested and refined during the 2001/2002 pilot):

1. Gambling Attitudes as measured by a 2 question scale (score range: -4 to +4, with positive scores reflecting positive attitudes) that measures people’s belief about the morality of gambling, and its harm versus benefit. This scale has a good one-month test-retest reliability (r = .78) (Williams, 2003). It also has good concurrent and predictive validity as evidenced by its significant correlation with current and future gambling behavior in the present study.

2. General knowledge of gambling and problem gambling as measured by the 10 question Gambling Knowledge Scale (score range: 0 to 10). This scale has good concurrent and predictive validity as evidenced by its significant negative association with gambling fallacies and problem gambling (i.e., DSM-IV-MR-J scores, see below) both at Baseline and Follow-Up in the present study.

3. Awareness of and resistance to common gambling fallacies as measured by the 10 question Gambling Fallacies Scale (score range: 0 to 10). This scale was adapted from Moore and Ohtsuka (1999) and measures the person’s knowledge of superstitious conditioning, the independence of random events, the illusion of control, the belief that one is luckier than other people, and sensitivity to sample size in probabilistic judgments. It has adequate 1-month test-retest reliability (r = .69) (Williams, 2003). It also has good concurrent and predictive validity as evidenced by its significant correlation with problem gambling scores on the DSM-IV-MR-J at both Baseline and Follow-Up.

4. Decision Making and Problem Solving Skill, as assessed by an 8 question scale (score range: 0 to 10) asking about self and other peoples’ rating of the person’s decision-making and problem solving in the past 3 months. The concurrent and predictive validity of this scale is evidenced by its significant negative correlation with High Risk Activities (see below) as well as DSM-IV-MR-J scores at Baseline and at Follow-Up.

5. Stated involvement in High Risk Activities in the past 3 months. This is a 9 question scale (score range: 0 to 10) asking about substance use, illegal behaviour (e.g, shoplifting), skipping school, driving while intoxicated, etc. The concurrent and predictive validity of this scale is evidenced by its significant positive correlation with both Baseline and Follow-Up scores on the DSM-IV-MR-J as well as a significant negative correlation with Baseline and Follow-Up scores on Decision Making and Problem Solving Skill.

6. Gambling Behavior in the past three months. Specifically, self-report of:

a. Whether the person had gambled.

b. Types of gambling engaged in.

c. Frequency of gambling (number of days gambled in the past 90).

d. Amount of money both won and lost gambling.

7. Problem Gambling in the past year.

a. The first measure used was the DSM-IV-Multiple Response-Juvenile (DSM-IV-MR-J) (Fisher, 2000). This is a 9 question scale developed for adolescents modeled after DSM-IV criteria for pathological gambling. A score of 4 or higher is indicative of ‘problem gambling’. This scale has previously demonstrated good internal consistency (Cronbach alpha = .75) (Fisher, 2000). However, its reliability has been questioned by Pelletier, Ladouceur, Fortin, Ferland (2004) who found a roughly 25% decrease in problem gambling when verbally readministering it to 265 grade 7 and 8 students who had just obtained the highest scores among 661 students who had just self-administered it in their classroom. However, it is unclear how much this reflects true test-retest unreliability or just the ‘demand characteristics’ of this reassessment procedure. The DSM-IV-MR-J has good construct validity in terms of its ability to reliably distinguish between social and pathological gamblers (Fisher, 2000). In the present study, it also evidenced statistically significant associations with gambling frequency (eta (η) = .87), money lost gambling (η = -.65), and gambling fallacies (η = .12) at Baseline. Unfortunately, due to a mistaken instruction in the Baseline Questionnaire, 25% of students did not complete the DSM-IV-MR-J.

b. Fortunately, a second measure of Self-Reported Problem Gambling was also employed. This was a 2-part question that asked students “Has your gambling caused you or anyone else any problems in the past 12 months? By this we mean things such as stress or anxiety, arguments with friends or family, worries about money, health problems, legal problems, or problems at school or work?” A follow-up question then asked the person to indicate the type of problems, their frequency, and their seriousness. The person was deemed a problem gambler if they reported ‘serious’ or ‘very serious’ problems of any frequency. In addition to having good face validity, this measure had a significant association with problem gambling status at Baseline as assessed by the DSM-IV-MR-J, although the magnitude of the correlation was not large, Cramer’s V = .31, p < .001. This measure also had a significant association with Baseline gambling frequency (η = .60), money lost gambling (η = -.47), and gambling fallacies (η = .11).

A Follow-Up Questionnaire containing these same scales was administered three to seven months (average of 4.1 months) after the program had ended. School breaks over the summer and other scheduling issues precluded a standard Follow-Up interval.

Results

Sample

The mean age of the students was 16.0 (SD = 1.0) ranging from 14 to 20 years of age. Eight percent were in grade 9; 33% in grade 10; 51% in grade 11; and 8% in grade 12. Fifty three percent were male. Approximately 67% identified their ancestry as primarily European, 8% East Asian, 3% South Asian, 3% Aboriginal, 2% African, 3% Latin American, and 13% Other.

Table 1 indicates the number of students in each of the three groups and the follow-up rates for each.

Analysis of Baseline Differences and Effects of Attrition

All variables were initially examined for accuracy of data entry, missing values, univariate outliers and normality. When missing values comprised less than 5% of the total data set for that variable, values were imputed using SPSS Linear Trend at Point for continuous variables and mode for discrete variables. The variables of high risk behaviour, gambling frequency, and money lost gambling were found to be skewed and had outliers at both Baseline and Follow-Up. Skewness and outliers were significantly reduced by winsorizing the top 1% of values for each of these variables.

Chi square tests for nominal variables and t-tests for continuous variables investigated whether the three groups differed at Baseline (p < .01) on the following variables: gender, age, grade, gambling attitudes, decision making skill, gambling knowledge, gambling fallacies, percentage of gamblers, high risk activity, gambling frequency, money lost gambling, and rates of problem gambling. Age and grade were found to be significantly lower in the Booster Group relative to the Standard and Control Groups. Hence, these two variables were entered as covariates in subsequent analyses.

The same procedure was used to determine whether there were any significant differences (p < .01) between students who completed the Follow-Up Questionnaire and those who did not. It was found that students who did not complete Follow-Up Questionnaires tended to be somewhat older and in a higher grade. There were no significant differences in gambling behaviour, problem gambling, gambling fallacies, gambling attitudes, decision making skill, or high risk behaviour.

Baseline Gambling Attitudes, Knowledge, and Behaviour

Attitudes, Knowledge, Gambling Fallacies. Most students were neutral or slightly negative in their attitudes towards gambling at Baseline (mean = -.28; SD = 1.7). Students possessed some knowledge about gambling and problem gambling at Baseline with the average score on this scale being 4.8 out of a possible 10 (SD = 1.5). The average number of correct answers on the gambling fallacies scale was 4.9 out of 10 (SD = 1.7).

Gambling Behaviour. Forty one percent of students reported having participated in at least one activity where they wagered money in the past three months (i.e., gambled). Among the 697 gamblers, the most common activities were betting on games of skill against other people (e.g., pool, golf, darts, video games) (56%); betting on card games (52%); sports betting (40%); gambling on dice games (28%); buying lottery and instant win tickets (21%); buying sports lottery tickets (14%); playing bingo (10%); playing video lottery terminals (VLTs) or slot machines (6%); and horse race betting (6%). In terms of frequency, 45% reported gambling once a month; 22% 2-3 times a month; 16% once a week; 12% 2-6 times a week; and 6% daily. Among gamblers, the median reported loss in the past 3 months was $10, with 90% reporting a loss of $75 or less. However, the overall median net win/loss was a reported win of $10. In fact, 79% of all gamblers reported having a net win over the past 3 months. Wood & Williams (2007) have documented that self-reported gambling expenditure tends to be very unreliable, and that reported losses tend to be more valid that reported net win/loss. Hence, net win/loss was not used in any of the subsequent analyses.

Problem Gambling. According to the DSM-IV-MR-J, 3.2% of students were problem gamblers at Baseline. According to the Self-Reported Problem Gambling measure, 5.2% of students were problem gamblers at Baseline. Among the Self-Reported Problem Gamblers, the most common gambling-related problems were: money worries (77%); school or work problems (76%); stress or anxiety (75%); problems with friends or family (74%); health problems (47%); and legal problems (39%).

Effects of the Prevention Program

The effects of the prevention program were assessed by means of Analysis of Covariance (ANCOVA) for repeated measures. A separate Group (Control, Standard, Booster) x Time (Baseline, Follow-Up) analysis was performed on each of the following dependent variables: Gambling Attitudes, Gambling Knowledge, Gambling Fallacies, Decision Making, High Risk Activity, Gambling Frequency, Money Spent Gambling, and Problem Gambling. Age and grade were entered as covariates. The main effect of interest was the Group x Time interaction. Changes in the Percentage of Gamblers and in the Percentage of Problem Gamblers from Baseline to Follow-Up were evaluated with McNemar tests. Results of these analyses are summarized in Table 2.

Attitudes. A statistically significant Group x Time interaction was obtained, F(2, 1235) = 15.4, p < .001. Post-hoc t-tests determined this interaction effect to be due to significantly more negative attitudes toward gambling from Baseline to Follow-Up in the Standard Group, t = 11.0, p < .001, and in the Booster Group, t = 8.94, p < .001, but not the Control Group, t = 1.72, p = .087. At Follow-Up, the attitudes in the Standard Group were also significantly more negative than the attitudes in the Control Group, t = 4.54, p < .001. Attitudes in the Booster Group were also significantly more negative than attitudes in the Standard Group, t = 2.50, p = .013.

Knowledge. There was a statistically significant Group x Time interaction, F(2, 1235) = 35.1, p < .001. Post-hoc t-tests determined this interaction to be due to significant gains in knowledge from Baseline to Follow-Up in the Standard Group, t = 13.6, p < .001, and in the Booster Group, t = 13.4, p < .001, but not the Control Group, t = 1.66, p = .098. At Follow-Up, the level of knowledge in the Standard Group was significantly better than the Control Group, t = 8.04, p < .001. The level of knowledge in the Booster Group was also significantly better than the level of knowledge in the Standard Group, t = 5.69, p < .001.

Gambling Fallacies. There was a statistically significant Group x Time interaction, F(2, 1235) = 34.4, p < .001. Post-hoc t-tests determined this interaction effect to be due to a significant decrease in gambling fallacies from Baseline to Follow-Up in the Standard Group, t = 11.1, p < .001, and in the Booster Group, t = 9.68, p < .001, but not the Control Group, t = .99, p = .326. At Follow-Up, the average number of gambling fallacies in the Standard Group was significantly lower than the number in the Control Group, t = 7.51, p < .001. However, average level of gambling fallacies in the Booster Group at Follow-Up was not significantly lower than that observed in the Standard Group, t = 1.65, p = .10.

Decision Making and Problem Solving. There was a statistically significant Group x Time interaction, F(2, 1235) = 6.29, p = .002. Post-hoc t-tests determined this interaction effect to be due to significant improvement in decision making and problem solving from Baseline to Follow-Up in the Standard Group, t = 4.41, p < .001, and in the Booster Group, t = 2.94, p = .004, but not the Control Group, t = 1.09, p = .275. At Follow-Up, Decision Making skills in the Standard Group were significantly better than the Control Group, t = 3.02, p = .003. However, Decision Making and Problem Solving in the Booster Group at Follow-Up was not significantly different from that observed in the Standard Group, t = .03, p = .98.

High Risk Activity. No significant Group x Time interaction was obtained, F(2, 1235) = .03, p = .86.

Percentage of Gamblers. A McNemar test found a significant decrease in the percentage of gamblers from Baseline to Follow-Up in the Standard Group, p < .001, as well as the Booster Group, p < .001, but not in the Control Group, p = .337. At Follow-Up a chi-square test determined that the percentage of gamblers in the Standard Group was significantly lower than the Control Group, χ2 (1df) = 23.5, p < .001. However, the percentage of gamblers in the Booster Group at Follow-Up was not significantly lower than the Standard Group, χ2 (1, N = 949) = 1.52, p = .218.

Gambling Frequency. There was a statistically significant Group x Time interaction, F(2, 1235) = 4.07, p = .017. Post-hoc t-tests determined this interaction effect to be due to a significant decrease in gambling frequency from Baseline to Follow-Up in the Standard Group, t = 4.42, p < .001, and in the Booster Group, t = 3.07, p = .002, but not the Control Group, t = .35, p = .728. At Follow-Up, the gambling frequency of the Standard Group was significantly lower than the Control Group, t = 5.1, p < .001. However, gambling frequency in the Booster Group was not significantly lower than the Standard Group, t = .47, p = .636.

Money Lost Gambling. There was no significant Group x Time interaction, F(2, 1235) = 1.74, p = .176.

Percentage of Problem Gamblers. Using DSM-IV-MR-J criteria, a McNemar test did not detect any significant change in the percentage of problem gamblers from Baseline to Follow-Up in either the Control Group, p = .388; Standard Group, p = .839; or Booster Group, p = .375. The rate of problem gambling in the Standard Group was also not significantly lower than the Control Group at Follow-Up, χ2 (1df) = 1.65, p =.199. However, there was a lower rate of problem gambling in the Booster Group relative to the Control Group at Follow-Up that was at significance, χ2 (1df) = 3.75, p = .053. The rate of problem gambling in the Booster Group was not significantly lower than that seen in the Standard Group, χ2 (1df) = 1.17, p = .279. Table 3 indicates the changes in problem gambling (PG) status from Baseline to Follow-Up in the three groups.

Using Self-Reported Problem Gambling criteria, a McNemar test did not detect any significant change in the percentage of problem gamblers from Baseline to Follow-Up in either the Control Group, p = .265; Standard Group, p = .312; or Booster Group, p = .143. However, the rate of problem gambling in the Standard Group was significantly lower than the Control Group at Follow-Up, χ2 (1df) = 4.61, p = .032, as was the rate of problem gambling in the Booster Group, χ2 (1df) = 6.17, p = .013. The rate of problem gambling in the Booster Group at Follow-Up was not significantly lower than the rate in the Standard Group, χ2 (1df) = .99, p = .319. Table 3 illustrates the changes in problem gambling status from Baseline to Follow-Up in the three groups.

Discussion

As expected, and consistent with previous research, the Stacked Deck program produced significant and sustained changes in attitudes, knowledge, and gambling fallacies. At Follow-Up the students in the Intervention Schools demonstrated significantly more negative attitudes toward gambling, greater knowledge of both gambling and problem gambling, and greater resistance to gambling fallacies. This is an important result, indicating that the content of the prevention curriculum was appropriate and delivered in a fashion that allowed for retention of this material. It is also likely the case that changes in these attributes are preconditions for actual changes in gambling behaviour.

In addition, the present program also produced significant improvements in reported decision making and problem solving skills, decreases in the number of gamblers, decreased gambling frequency, and, most importantly, evidence of decreased rates of problem gambling. (The failure to find unambiguous decreases in problem gambling rates is likely due to low statistical power. The failure to find significant decreases in gambling monetary losses is partly due to the low average amounts being wagered plus the high variability in these amounts). To our knowledge, this is the first time that a school-based problem gambling prevention program has produced actual behavioural changes.

An argument can be made that decreased gambling participation may not be an appropriate goal of problem gambling prevention, when gambling is a normative activity in western society as well as a nonproblematic activity for the large majority of people who engage in it (including high school students). However, as seen in the present study, gambling is not a normative activity among adolescents, and some types of gambling they report engaging in are illegal for their age group. Second, a decrease in gambling may well be appropriate outcome when considering that our primary goal was for students to decrease behaviour that can be construed as ‘bad gambles’ (i.e., when the odds are not in your favour and when the advantages of engaging in the behaviour are less than the disadvantages). Finally, a decrease in the rate of problem gambling is definitely an appropriate measure of effectiveness, and it is hard to imagine this occurring without a concomitant decrease in overall gambling involvement.

There are several important differences with previous programs that may explain why behavioural change was obtained in this study and not in others.

1. Targeting of entire cohorts of students so as to include most of their peers was unique to the present study.

2. The focus on improving decision making and problem solving was somewhat unique, as was the reported improvement in these skills. However, the failure of this improvement in decision making and problem solving to decrease other high risk behaviours (e.g., substance use) makes it uncertain about their role in the decrease in gambling behaviour.

3. The orientation of the program is somewhat different in its advocating ‘smart gambling/risk taking’ rather than avoidance.

4. The average age of the students (16) is older than other studies which have typically used elementary school students. These other studies are following a common prevention strategy which is to intervene prior to the onset of the behaviour. This is certainly appropriate for prevention of tobacco and illicit drug use where noninvolvement is the goal and where delay of onset beyond teenage years is strongly predictive of ongoing abstinence. However, it is unclear whether this strategy makes sense for a normative behaviour such as gambling, especially when some of the important concepts (i.e., probabilities, independence of random events, law of large numbers, etc.) require a degree of mathematical and intellectual sophistication to appreciate. A stronger case can potentially be made for intervening prior to the typical onset of problem gambling, which does appear to be present in high school students. However, ‘problem gambling’ does not appear to be a very stable or well formed entity in adolescents, as Table 3 shows that only a minority of problem gamblers at Baseline were still problem gamblers at Follow-Up (including students in the Control Group). The ability of the Stacked Deck program to help facilitate this change from problem gambler to nonproblem gambler status provides evidence of its utility in this age group.[1]

5. Perhaps the most important difference with previous studies is the much heavier emphasis on the development and retention of skills, accomplished by making the program much longer (up to 600 minutes over 6 sessions), by spaced administration of lessons, and by its interactive and skill oriented content. The superiority of the Booster Program over the Standard Program in some areas supports the notion that length and spacing is a contributing factor to the program’s effectiveness. However, the comprehensiveness of the program is also likely important, as the authors have implemented other, even more substantive prevention initiatives in focused areas (i.e., mathematics of gambling) to university students that have failed to produce behavioural change (Williams & Connolly, 2006). The authors appreciate the difficulty in incorporating large multi-session programs into already tight high school curriculums. However, it is important to recognize that the limited effectiveness of most current problem gambling educational and policy initiatives has to do with the fact that the ones that are implemented tend to be those that cause the least inconvenience, and consequently, have the least actual impact (Williams et al., 2007a; 2007b). We believe that problem gambling prevention needs to aspire to avoid the situation found in the substance abuse area, where the most commonly used (and entrenched) prevention and treatment interventions tend to be the less effective ones (e.g., Miller, Wilbourne, & Hettema, 2003). Efficiencies may be obtained if the Stacked Deck program was administered in conjunction with prevention modules for tobacco, illicit drugs, etc., because of potentially common content with respect to improving decision making, social problem solving, and coping skills.

Limitations

The present results indicate that the Stacked Deck program has promise as a primary problem gambling prevention initiative. However, there are certain cautions to bear in mind. One is that the long-term impact of this program is uncertain beyond four months. Another is that while we anticipate the program should achieve similar results in all high school students, it is uncertain how transferable the program is to jurisdictions with a different availability of gambling and/or a different cultural approach/understanding of gambling. A final issue is that we are uncertain about the ‘active ingredients’ of the program that contributed to the effects. It may be useful for future research to ‘dismantle’ the program so as to determine these vital components.

Table 1. Sample Sizes and Follow-Up Rates for each Group.

| |Baseline |Follow-Up |

|Standard Program | 911 |682 (74.9%) |

|Booster Program | 342 |267 (78.1%) |

|Control Group | 433 |291 (67.2%) |

|Total |1686 |1240 (73.5%) |

Table 2. Changes in Dependent Variables from Baseline to Follow-Up in the Three Groups

| | |Baseline | Follow-Up | |

| | |M (SD) |M (SD) | |

|Gambling Attitudes |Control Group |-.33 (1.8) |-.52 (1.7) | |

|(-4 to +4) | | | | |

| |Standard Program |-.24 (1.7) |-1.06 (1.7) |* † |

| |Booster Program |-.38 (1.7) |-1.37 (1.7) |* †† |

|Gambling Knowledge |Control Group |4.66 (1.4) |4.84 (1.6) | |

|(0 to 10) | | | | |

| |Standard Program |4.72 (1.6) |5.73 (1.6) |* † |

| |Booster Program |4.94 (1.4) |6.39 (1.7) |* †† |

|Resistance to |Control Group |5.01 (1.7) |4.89 (1.8) | |

|Gambling Fallacies | | | | |

|(0 to 10) | | | | |

| |Standard Program |4.95 (1.8) |5.94 (2.1) |* † |

| |Booster Program |4.86 (1.7) |6.19 (2.0) |* † |

|Decision Making & Problem Solving |Control Group |5.83 (1.6) |5.71 (1.8) | |

|(past 3 months; 0 to 8) | | | | |

| |Standard Program |5.74 (1.8) |6.07 (1.7) |* † |

| |Booster Program |5.77 (1.7) |6.06 (1.8) |* † |

|High Risk Activities |Control Group |1.68 (1.7) |1.64 (1.6) | |

|(past 3 months; 0 to 9) | | | | |

| |Standard Program |1.59 (1.5) |1.63 (1.7) | |

| |Booster Program |1.79 (1.4) |1.83 (1.6) | |

|Gamblers |Control Group |46.4% |43.0% | |

|(past 3 months) | | | | |

| |Standard Program |39.7% |27.1% |* † |

| |Booster Program |41.9% |23.2% |* † |

|Gambling Frequency |Control Group |15.87 (44.3) |16.78 (35.5) | |

|(all participants; # days gambling in| | | | |

|past 90) | | | | |

| |Standard Program |13.88 (41.0) |6.91 (23.9) |* † |

| |Booster Program |13.27 (39.4) |6.12 (21.1) |* † |

|Money Lost Gambling |Control Group |$5.88 (21.2) |$5.18 (19.9) | |

|(all participants; | | | | |

|past 3 months) | | | | |

| |Standard Program |$5.66 (22.3) |$3.52 (18.9) | |

| |Booster Program |$7.77 (28.8) |$3.01 (17.7) | |

|Problem Gamblers |Control Group |3.0% (6/197) |5.1% (10/197) | |

|DSM-IV-MR-J | | | | |

|(past 12 months) | | | | |

| |Standard Program |3.5% (16/462) |3.0% (14/462) | |

| |Booster Program |3.1% (6/193) |1.6% (3/193) | † |

|Problem Gamblers |Control Group |4.8% (14/291) |7.2% (21/291) | |

|Self-Reported | | | | |

|(past 12 months) | | | | |

| |Standard Program |5.1% (35/682) |4.0% (27/682) | † |

| |Booster Program |5.2% (14/267) |2.6% (7/267) | † |

| |

|* significant change (p < .05) from Baseline |

|† significantly different (p < .05) from Control Group at Follow-Up |

|†† significantly different (p < .05) from Control Group and Standard Group at Follow-Up |

Table 3. Changes in Problem Gambling (PG) and NonProblem Gambling (NPG) Status from Baseline to Follow-Up in the Three Groups

| | |Follow-Up |

|DSM-IV-MR-J Criteria | | |

| | |NPG |PG |

|Control Group |Baseline |NPG |256 |18 |

| | |PG |11 |3 |

|Standard Program |Baseline |NPG |627 |20 |

| | |PG |28 |7 |

|Booster Program |Baseline |NPG |248 |5 |

| | |PG |12 |2 |

| | |Follow-Up |

|Self-Reported | | |

|Problem Gambling Criteria | | |

| | |NPG |PG |

|Control Group |Baseline |NPG |183 |8 |

| | |PG |4 |2 |

|Standard Program |Baseline |NPG |435 |11 |

| | |PG |13 |3 |

|Booster Program |Baseline |NPG |186 |1 |

| | |PG |4 |2 |

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Author Note

Robert J. Williams is a Professor in the School of Health Sciences at the University of Lethbridge, Lethbridge, Alberta, as well as a Coordinator for the Alberta Gaming Research Institute. Robert T. Wood is an Associate Professor in the Department of Sociology at the University of Lethbridge, Lethbridge, Alberta. Shawn R. Currie is an Adjunct Associate Professor in both the Departments of Psychology and Psychiatry at the University of Calgary.

This study was funded by the Alberta Gaming Research Institute. The authors would like to thank the Institute for their financial support; the Research Assistants who skillfully administered the program (Lyndsey Dangerfield, Tammy Gillis, Jordyn Karltyn, Sonya Malhotra, and Margie Spry); and all the School Boards and individual students who participated.

SUPPLEMENTAL ONLINE MATERIAL

Appendix A: ADOLESCENT GAMBLING QUESTIONNAIRE - BASELINE

Please complete this questionnaire. Your responses will be kept confidential. Neither your parents nor your teachers will see your answers. Please do not write your name on this questionnaire.

Today’s Date____________________________________ School________________________________________

What grade are you in?_______ What is your date of birth? ______ (day) _______(month)_______(year)

Are you a boy _____ or girl _____ What is your mother’s first name?_____________________________

What are the last 2 digits of your phone number? _____ _____

Many of us have ancestors from different ethnic and racial backgrounds. Of the following categories, which one would you say MOST describes your ancestry:

European

East Asian

South Asian

Aboriginal

African

Latin American

Other (specify)____________________________________

What religion are you

Protestant

Catholic

Latter Day Saints

Islamic

Jewish

Buddhist

Hindu

None/Athiest/Agnostic

Other (specify)_____________________________________

How often do you take risks?

very often

often

occasionally

rarely or never

Do you tend to do things impulsively (without thinking of the consequences)?

very often

often

occasionally

rarely or never

Gambling is defined as wagering something of value (usually money) on something with an uncertain outcome. It includes things such as lottery tickets, bingo, slot machines, casino table games (e.g., roulette, blackjack), betting on horse racing, betting on sports, or betting against other people on games of skill (e.g., pool, cards, golf, etc.).

Have you ever made a bet for money (where you or the other person paid up)?

a. No

b. Yes -> How old were you when you first did this?______

What is the largest amount of money you personally have ever won from gambling on a single occasion? $_______

What is the largest amount of money you personally have ever lost from gambling on a single occasion? $_______

1) Which best describes your belief about the benefit or harm that gambling has for society?

a. The benefits far outweigh the harm

b. The benefits somewhat outweigh the harm

c. No opinion one way or the other

d. The harm somewhat outweighs the benefits

e. The harm far outweighs the benefits

2) Which best describes your attitude toward gambling?

a. It is very morally wrong

b. It is somewhat morally wrong

c. No opinion one way or the other

d. It is a matter of personal choice

e. is a fun, harmless thing to do

1) It is legal for persons under 18 years old to purchase lottery and instant win tickets.

a. True

b. False

c. Unsure

2) Gambling can become as addictive as drugs or alcohol.

a. True

b. False

c. Unsure

3) The most addictive form of gambling tends to be

a. lottery tickets

b. slot machines and VLTs

c. Sports Betting

d. Bingo

e. All of the above are equally addictive

4) What is your best guess about how common ‘problem and pathological gambling’ is in the Alberta population?

a. 1 out of every 1000 people

b. 2-3 out of every 100 people

c. 7-8 out of every 100 people

d. 10-15 out of every 100 people

5) You go to a casino with $100 hoping to double your money. Does the number of bets you make influence your chances of doubling your money?

a. No

b. Yes, betting small amounts of money on several different bets gives you the best chance.

c. Yes, betting the $100 on your first (and only) bet gives you the best chance.

6) If you use the right system, you can reliably beat which game at the casino?

a. Slot machines

b. Roulette

c. Dice games (e.g., craps)

d. All of the above

e. None of the above

7) Which of the following is a risk factor for becoming a problem gambler?

a. parents who are problem gamblers

b. drug abuse

c. gambling at an early age

d. all of the above

e. none of the above

8) What is the name of the Alberta government agency that provides treatment for gambling problems?______________

9) Which age group has the highest rates of problem gambling?

a. Teenagers and people in their early 20’s

b. people in their 30’s

c. people in their 40’s

d. people in their 50’s

e. people age 65 and older

10) Which of the following has the lowest probability of occurring this year ?

a. being killed in car crash

b. being murdered

c. winning Lotto 6/49

d. being hit by lightning

1) Which of the following Lotto 6/49 numbers has the greatest probability of being selected as the winning combination?

a. 1, 2, 3, 4, 5, 6

b. 9, 19, 21, 32, 33, 47

c. 2, 4, 6, 8, 10, 12

d. all of the above have an equal probability

2) Some people seem luckier than other people when it comes to games of chance such as bingo. What is the most likely reason for this?

a. Some people are just naturally luckier than other people.

b. People who win more often usually have also lost more often.

c. Unsure.

3) Which gives you the best chance of winning the jackpot on a slot machine?

a. Playing a slot machine that has not had a jackpot in over a month.

b. Playing a slot machine that had a jackpot an hour ago.

c. Your chances of winning the jackpot are the same on both machines.

4) A certain individual is very confident, outspoken, and patriotic. What is your guess about the most likely place this person comes from?

a. Canada

b. United States

c. Asia

d. The person is equally likely to come from any of these countries

5) A few hands of Blackjack or Poker are enough to let you know whether you’re “hot” or “cold.” If you’re “cold,” it’s a good idea to quit and play again some other day.

a. strongly agree

b. slightly agree

c. unsure

d. past luck has no influence on future luck

6) On average, which type of slot machine would likely cause people to play the longest and spend the most money?

a. A machine that often gave a big win (e.g., $100) early on and the occasional small win (e.g., $5) thereafter.

b. A machine that gave lots of ‘near misses’ all the time, but very few actual payouts.

c. A machine that gave a small win (e.g., $5) fairly often, but almost never gave a large payout.

7) Do more Canadians die from accidents or strokes?

a. accidents

b. strokes

8) How lucky are you? If everyone’s name in your current class was put into a hat and one name drawn for a prize, how likely is it that your name would be chosen?

a. Much less likely than other people

b. Less likely than other people

c. About the same likelihood as everyone else

d. Your name is more likely to be chosen

e. Your name is much more likely to be chosen

9) If you were to buy a lottery ticket, which place would you be most likely to buy it from?

a. a place that has sold many previous winning tickets

b. a place that has sold few previous winning tickets

c. a place that has never sold a winning ticket

d. any place is as good as another

10) Your chances of winning a lottery are slightly increased if you are able to choose your own numbers.

a. agree

b. unsure

c. disagree

1) Think of the major decisions you have made in the past 3 months. How often did you do a thorough and objective analysis of the odds of success and pros and cons of your decision before making your decision?

a. rarely

b. sometimes

c. about half the time

d. most times

e. almost every time

2) Think of the major personal and social problems you have encountered in the past 3 months. How often did you brainstorm several different possible solutions and carefully weigh the pros and cons of each solution?

a. almost every time

b. most times

c. about half the time

d. sometimes

e. rarely

3) Think of the major decisions you have made in the past 3 months. How often did your decision prove to be the right one to make (for the ones where you know the outcome)?

a. almost every time

b. most times

c. about half the time

d. sometimes

e. rarely

4) Think of the major personal and social problems you have encountered in the past 3 months. How often were your solutions for these problems successful (for the ones where you know the outcome)?

a. rarely

b. sometimes

c. about half the time

d. most times

e. almost every time

5) How do you think your parent(s) would rate you as a decision maker and problem solver?

a. very good

b. good

c. average

d. fair

e. poor

6) How do you think your friends would rate you as a decision maker and problem solver?

a. poor

b. fair

c. average

d. good

e. very good

7) How would you rate yourself as a decision maker and problem solver?

a. very good

b. good

c. average

d. fair

e. poor

8) How good are you at resisting peer pressure to do things that you don’t really want to do (e.g., in past 3 months)?

a. poor

b. fair

c. average

d. good

e. very good

1) Have you ever done any of the following, or have any of the following ever happened to you? CIRCLE ALL THAT APPLY

a. dropped out, been suspended or expelled from school

b. repeated a grade

c. smoked cigarettes

d. used alcohol

e. used illegal drugs

f. done an illegal act (i.e., shoplifting, break and enter, theft, drug trafficking, arson, causing a disturbance, vandalism, assault, etc.)

g. been arrested by the police or placed on probation

h. been seriously depressed for a 2-week period or more

i. attempted suicide

j. received treatment for either a drug or mental health problem

k. been placed in a foster home

l. one or both of your parents has had a drug or alcohol problem

m. one or both of your parents has spent time in jail

n. one or both of your parents has had a mental health problem

o. one or both of your parents has had problems with gambling

2) What was your average grade on your last report card?

a. 80% or higher

b. 70 – 79%

c. 60 – 69%

d. 50 – 59%

e. below 50%

3) How often have you skipped classes in the past 3 months?

a. Not at all

b. 1-5 times

c. 6-10 times

d. 11-20 times

e. 21 or more times

4) Have you dropped out or been suspended or expelled in the past 3 months?

a. No

b. Yes

5) How often have you smoked cigarettes in the past 3 months?

a. Not at all

b. Less than weekly

c. weekly

d. several times a week

e. daily

6) How often have you used alcohol in the past 3 months?

a. Not at all

b. Less than weekly

c. weekly

d. several times a week

e. daily

7) How often have you used illicit drugs (e.g., marijuana, acid, mushrooms, Ecstasy, PCP, crystal meth, etc.) in the past 3 months?

a. Not at all

b. Less than weekly

c. weekly

d. several times a week

e. daily

8) How often have you engaged in illegal behaviour (shoplifting, break and enter, theft, drug trafficking, arson, causing a disturbance, vandalism, assault, etc.) in the past 3 months?

a. Not at all

b. once

c. 2-3 times

d. 4-6 times

e. 7 or more times

9) How often have you exercised in the past 3 months?

a. several times a week

b. once or twice a week

c. 3-6 times

d. 1-2 times

e. Not at all

10) How often have you done any of the following in the past 3 months: ridden in a car without wearing your seatbelt; accepted a ride from someone who was driving under the influence of drugs or alcohol; or driven while under the influence of drugs or alcohol?

a. never

b. once

c. 2 – 3 times

d. 4 – 6 times

e. more than 7 times

| |Check off how often you bet or personally |About how much money did you win or lose on |

| |spent money on the following activities in |each of these activities in the past 3 months|

| |the past 3 months | |

| |daily |2 - 6 times/week |1/week |2 - 3 times/month |1/month |

|Stress or anxiety | | | | | |

|Money worries | | | | | |

|Legal problems | | | | | |

|School or work problems | | | | | |

|Problems with friends or family | | | | | |

|Health problems | | | | | |

5) Are there other people who would say that your gambling has caused serious problems in the past 12 months?

a. No, no one would say that ( YOU ARE FINISHED THE QUESTIONNAIRE

b. Yes, there is at least one person who would say that

7) In the past 12 months how often have you found yourself thinking about gambling or planning to gamble?

a. never

b. once or twice

c. sometimes

d. often

8) During the course of the past 12 months have you needed to gamble with more and more money to get the amount of excitement you want?

a. Yes

b. No

9) In the past 12 months have you ever spent much more than you planned to on gambling or been unsuccessful at cutting down or stopping your gambling?

a. never

b. once or twice

c. sometimes

d. often

10) In the past 12 months have you felt bad or fed up when trying to cut down or stop gambling?

a. never

b. once or twice

c. sometimes

d. often

e. never tried to cut down

11) In the past 12 months how often have you gambled to help you to escape from problems or when you are feeling bad?

a. never

b. once or twice

c. sometimes

d. often

12) In the past 12 months, after losing money gambling, have you returned another day to try and win back money you lost?

a. never

b. less than ½ the time

c. more than ½ the time

d. every time

13) In the past 12 months has your gambling ever caused you to lie to your family?

a. never

b. once or twice

c. sometimes

d. often

14) In the past 12 months have you ever taken money from the following without permission to spend on gambling: school lunch money or fare money? Money from your family? Money from outside the family?

a. never

b. once or twice

c. sometimes

d. often

15) In the past 12 months has your gambling ever led to: Arguments with family/friends or others? Missing school?

a. never

b. once or twice

c. sometimes

d. often

16) In the past 12 months have other people had to pay your gambling debts or other bills because of your gambling?

a. never

b. once or twice

c. sometimes

d. often

-----------------------

[1] The ascertainment of problem gambling in adolescents is an under researched and controversial area (Derevensky, Gupta, & Winters, 2003). There is good evidence that certain instruments have produced elevated prevalence rates due to measurement error (i.e., South Oaks Gambling Scale and South Oaks Gambling Scale Revised for Adolescents) (Ladouceur, Bouchard, Rheaume et al., 2000). The possibility also exists that the instability in problem gambling seen in the present study reflects a measurement problem. A team of researchers under the aegis of the Canadian Centre on Substance Abuse has been working on the development of a new, well validated instrument for the past several years.

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